The Drug-Induced Respiratory Disease Website and App

Abused drugs/substances (illicit-, street drugs - IV/inhaled)

Specialities: Addiction medicine · Emergency medicine · Forensic medicine/pathology · Law enforcement · Ophtalmology · Pulmonary medicine

Illicit or 'street' drugs, substances, chemicals and synthetic compounds whether inhaled or i.v. (IVDU) can produce a vast array of respiratory manifestations and complications, that can be life-threatening or fatal (PMID 24144776). These encompass bacterial infections which can involve the lung, pleura, chest wall and heart (PMID 16267325). Links to street names, nicknames of drugs and slang to facilitate history taking are included in a 'News' on right called 'Glossary of drug-related slang/street language'. See also under cocaine, heroin, methamphetamine, opiates, narcotics, vehicle, solvents, talc, starch, cellulose and mercury, alc and/or silica may also be an issue. For imaging, see PMID 8416551, 12376606, 17527131, 23168064, 24144776. The homeless is particularly at risk (PMID 30324539). The 'World Drug Report' provides updated data on the prevalent use and consumption of §abused drugs. See also under body-packing/packers. See also under 'talc retinopathy'.

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.e

Acute eosinophilic pneumonia (AEP)

I.j

Exogenous lipoid pneumonia (subacute, acute)

I.m

ILD with a granulomatous component

I.s

A mass or masses

I.t

Pneumoconiosis (silicosis, talcosis...)

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)

II.b

ARDS - Acute lung injury

III - Pulmonary/alveolar/airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

IV - Airway involvement

IV.a

Bronchospasm - Wheezing - Asthma

IV.f

Severe or catastrophic bronchospasm or asthma attack (can be fatal)

IV.g

Cough syncope

V - Pleural and/or pericardial involvement

V.f

Pneumothorax

V.q

Empyema

V.ab

Pneumothorax, bilateral

VI - Pulmonary vasculopathy

VI.b

Pulmonary arterial hypertension

VI.c

Pulmonary veno-occlusive disease

VI.g

Foreign body pulmonary vasculopathy (Excipient lung disease)

VI.i

Acute pulmonary hypertension

VI.j

Mercury pulmonary embolism

VI.r

Septic pulmonary embolism

VI.t

Pulmonary artery aneurysm(s)

VII - Mediastinal involvement

VII.h

Pneumomediastinum

VII.i

Mediastinitis

VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement

VIII.c

Upper airway obstruction other than angioedema or hematoma

VIII.d

Thermal (burns, frostbite), chemical or caustic injury on the face, mouth, tongue, pharynx or upper airway

VIII.ai

Nasal, palatal and/or pharyngeal pathology

IX - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

IX.a

Diaphragm/inspiratory muscle weakness/paralysis (w/wo ARF)

IX.s

Botulism (foodborne-, wound-)

IX.ah

Acute myelopathy (can cause ARF)

X - Systemic/Distant conditions, syndromes and reactions

X.m

Vascultis (pulmonary, extrathoracic or systemic)-ANCA status unknown or negative)

X.u

Multiple organ dysfunction/failure (MODS/MOF)

X.ac

Anti-GBM antibody disease (Goodpasture-like or flare of preexisting GS)

X.bb

Foreign body (talc, cornstarch) retinopathy

XI - Miscellaneous

XI.b

Chest pain (acute or subacute), lone or prominent

XI.g

Aspiration, aspiration pneumonia (w/wo demonstrable pharyngeal dysmotility)

XI.m

Pulmonary emphysema - Lung cysts or bullae

XI.r

Death following exposure or poisoning

XII - Cardiovascular involvement / toxicity

XII.g

Coronary artery disease (acute) - Myocardial ischemia/infarction

XII.i

Endocarditis (infective)

XII.v

Hypertrophic cardiomyopathy

XV - Pathology

XV.q

Path: Foreign body deposits/granulomatous reaction

XV.s

Path: Pneumoconiosis (silicosis, talcosis, talcoma)

XV.v

Path: Micronodular organizing pneumonia/BOOP

XV.ag

Path: Foreign body embolism, microangiopathy, vasculopathy

XV.al

Path: Pulmonary hypertension incl. angiomatoid vasculopathy

XVI - Imaging

XVI.d

Imaging: Alveolar opacities or haze with a batwing or butterfly distribution

XVI.u

Imaging: A miliary pattern (diffuse random micronodules)

XVI.v

Imaging: Centrilobular micronodules (can be diffuse)

XVI.ab

Imaging: Cavitating/cavitary lung nodule, mass or nodules (see also Iq, XIs, XIIi, XVIaa and XVIIp)

XVI.ae

Imaging: A pattern similar to pneumoconiotic progressive massive fibrosis (PMF)

XVI.af

Imaging: Lung cysts or bullae (see also XVI ah/bf)

XVI.ai

Imaging: A 'tree-in-bud' pattern

XVII - Infections & related conditions

XVII.a

Respiratory tract infection incl. pneumonia

XVII.b

Opportunistic pulmonary/systemic infections

XVII.g

Tuberculosis (pulmonary, pulmonary, extrapulmonary or disseminated). Reactivation or de novo

XVII.p

Lung abscess/abscesses (see also VIr)

XVII.s

Sternoclavicular septic arthritis

XVII.u

Epidural abscess

XVII.al

Osteomyelitis (notably of thoracic bones)

XVIII - Distinctive patterns - 'Eye-catchers'

XVIII.t

Eye catcher: Purpuric/Ecchymotic/Cyanotic lesions of the earlobes and/or nose

XVIII.u

Eye catcher: Talc retinopathy

XVIII.x

Eye catcher: A batwing pattern on imaging